Medical Illustrations of Metoidioplasty
Tissue Expansion Prior to Insertion of Testicular Implants:
Tissue Expansion Prior to Insertion of Testicular Implants:
First photo shows the scar from where the skin was taken for my glans sculpting. Where it’s slightly wider is where it got infected after stage two and made holes that annoyingly went down into the lower dermis.
The scar is about three inches long and placed on my hip (a hairless part which is what they needed).
Second photo is my lower stomach / pubic region. Here you can see the long scar that runs down to the base of my penis. This is five inches long in total. The newer/redder part is where it was reopened so the erectile device reservoir could be placed under muscle here. That part is two inches long. It’s actually in a slightly different place than I was told it’d be due to a tattoo Mr Christopher didn’t want to disturb. Don’t mind that as it’s just incorporated them both which is fine by me! I can feel stitches underneath the red part where I think muscle was stitched back together. This is the part I was told to be careful about in regards to heavy lifting as it was like a hernia operation.
The other little scar more to the centre, is the scar from where the suprapubic catheter came out of me.
Finally there’s just 3 photos of my arm scar on all sides at almost one year post op. Still looks pretty red and has raised scars on, but I’m not surprised as I do scar badly. Parts of it are fading well, but the keloid part is stubborn and the whole top side looks pretty savage as there’s the large scar from where tissue has to regrow.
You can also see little scabs from where I constantly knock my arm and it gets damaged. The skin is pretty weak on some parts and so my clumsy self often finds I’ve hurt it a little. Can’t feel it at all though!
I can’t actually believe it’ll be a whole year since my stage one in just five days time… I’m glad to be in a better place than I was even three weeks ago, but I also can’t believe a whole year has disappeared from surgery and healing…
Still have a bit of healing to do from my proper stage two, but I can stand to void and holy shit that’s amazing. So maybe in the grand scheme of things a lost year is worth it :)
There may not be many updates for a while now. I feel as if it’ll just be further scar updates really. I am unsure if I need a small revision on parts of my scrotoplasty/vaginectomy as it’s healed strangely, but I’m not planning on having more surgery until next year probably.
I’m happy to keep answering questions though!
from a tatooed man to a guiness video to this here penis. oh youtube.
either way i’m glad i found it cuz there’s nothing like this anywhere in relation to phallo and this closely relates. so here you can see how to inflate and deflate the prosthetic which is actually pretty cool.
Dr. Bowers is the only person currently performing Ring Metoidioplasty. If you’re leaning more towards a simple metoidoplasty/release then the following surgeons, if I remember correctly, offer this procedure:
- Dr. Mari Bowers
- Dr. Christine McGuinn
- Dr. Toby Meltzer
- Dr. Pierre Brassard
Finding the costs for the procedure isn’t very easy as this depends on what all you want done. Costs will vary based on if you want a vaginectomy, urethral lengthening, scrotoplasty, a fused scrotum, etc. Many surgeons also don’t put their prices directly online, so you have to contact them yourself either by email or phone and ask what the total price would be for the operation you’d like. This website can give you a basic idea of the costs, but it’s broken down in to package deals and doesn’t list what a simple meta would cost for each surgeon. I’d advise you to contact each of those surgeons and ask what the pricing would be like and what options are available.
The weight limit Dr. Bowers suggests for simple metoidioplasty is there for a reason though, which is explained on the information page. “Because of the tendency for the neophallus to remain hidden in mons fat, a weight maximum of 185 pounds is suggested for either Meta and/or with minimal mons fat.” This doesn’t mean you aren’t able to have the operation done - it just means that at a higher weight there is a tendency for the mons to have more fat tissue, which can hide the phallus. The problem will remain no matter who the surgeon is. To avoid that they’d recommend losing weight (which I understand is a very difficult process) and/or having a mons resection done.
It’s estimated that in 7 years using a 3D printer and stem cells to ‘print’ skin grafts will be commonplace, which gets rid of the need for donor sites. This is an estimation for how soon it will be for this process to be commonly used, so with an ambitious surgeon you could see about testing out this technology even sooner (closer to 5 or 6 years).
This post has more information on both the current surgical results of phalloplasty and the current research going into phalloplasty. Notably, it talks about how soon we could have surgical results that get erect on their own and have little to no need for donor sites. Science and medicine really are incredible.
9 weeks post op :-)
At the end of may I made a trip to Harley Street in London to see Dr Christopher to discuss bottom surgery. Was I nervous? A little. But I knew exactly what procedure I want, and I knew pretty much everything he was going to tell me, I just had a few questions myself.
Harley Street is unreal, in the sense that all the buildings are phenomenal, the cars parked outside them are even more phenomenal and I didn’t at all feel like I belonged there. The clinic itself was like something out of a film, ceilings so high you’d need ladders to change a light bulb in the chandeliers, black and white Victorian tiled floors, a huge reception are, framed paintings on the walls, everything glistened etc, you get the picture.
I had to sign a form to take up to Dr C, and waited in the waiting room that had proper sofas in until I was called. I went with my mum and Kerry, but my mum stayed in the waiting room as Kerry and I saw Dr C. My first impression of him? Well, deffo not what I was expecting a top rate surgeon to look like. He was extremely overweight, but seemed very friendly and was cracking lots of jokes, he instantly made me feel more relaxed.
He began by asking if I knew what surgery I wanted, to which I replied radial forearm phalloplasty. He asked to look at my non dominant arm (my left) to assess if I would be a good candidate for that technique, and told me I had the perfect arm, the right amount of fat, not too much nor too little, and my arm hair wouldn’t present a problem (If hair travels around to the inner side of the forearm it could present a problem as that part of the arm is what forms the urethra). This was the best news I could of hoped for.
He then went through how many stages there would be, exactly what happens in each stage, accompanied by images on a slide show from surgeries he’d performed. For me, there will be 3. Firstly; creation of the new phallus, urethral lengthening, and skin graft from the bottom of buttocks to cover arm. This is the longest most complex stage, surgery is 8-10 hours. Second stage; laparoscopic hysterectomy, oophorectomy and vaginectomy, along with burial of the clitoris, nerve hookup and glans sculpting, as well as one testicle implant. This is said to be the most painful stage due to the vaginectomy. Then the third and final stage is the insertion of the erectile implant, which makes up the second testicle as I opted for the cylinder pump implant. There will be around 3/4 months between each stage.
He also went through all the risks and possible complications, which I was pretty much already aware of. I can’t remember the exact percentages, but he said most people have sensation, both tactile and erotic. Total loss of all sensation wasn’t very common at all, and loss of the phallus was either 3 or 5% so I’m not too worried about that. I know that radial forearm with nerve hookup has the best statistics in terms of sensation recovery and also gain.
He also showed me results from over a year of healing and most of the arm scars looked fantastic, and I know my body is good at healing and scarring so I’m very optimistic about that aspect. If not, I’ve already got a tattoo idea planned to cover up. The general size of the completed phallus is 5/5.5 inches, which I’m more than happy with. The only worry is girth size being too big, but he said that wouldn’t be a problem to revise and the first few months would be swelling anyway.
My main query was delaying the surgery until Autumn 2015 due to university, I don’t want to disrupt my final year and jeopardise anything as I’m doing so well right now. Dr C said he didn’t see any real issues with that other than contacting CHX, as they prefer to do the surgery within a year of referral due to this and that, but if CHX were happy for that time then Dr C was fine with it as he said he was willing to do that date for me. And tbh, I know CHX won’t have any issues with that as when they dismissed me they said I was one of the easiest patients to refer etc and they were very confident of my treatment. So he’s pencilled me in for Sept/Oct 2015 and should be in contact again at some point next year. So I have a year to prepare, finish uni, graduate and make sure I’m in the best of health/ look after my body.
I also asked about hair removal, and we both agreed that waiting til after would be for the best as long as I wasn’t shy about whacking my wang out in a hair removal clinic! My main reasoning being my arm hair is mostly fine hair anyway, and I don’t want to remove my entire arms worth of hair as the graft area isn’t my entire arm. And I like the hair going from my wrist to my hand.
His final warning to me was to not break my arm. I’ve gone 21 years without breaking a bone, so now I’m super concious of making sure nothing happens to that arm haha!
Finally, he marked up on my arm the area that would be taken:
I’ve highlighted the area that would be taken in yellow to make it more clear, and below the orange details which area of the graft would be used for the urethra.
And finally, the strip down the centre is what will be left.
All in all the consult took about 15 minutes, and I left very happy. I’m not apprehensive about it, I know what’s to come and I know its going to be very hard, both mentally and physically, but to me it’s going to be worth it.
And finally, my phalloplasty will be covered by the NHS, but if you’re considering going private, it will cost £50,000+.
Everyone seems to ask me whether phalloplasty was worth it when they find out about my complications so I decided to make a post about it.
The answer is yes. Definitely.
My complications have caused a lot of pain and suffering. I had a catheter in for almost an entire year. Pissing myself wasn’t an uncommon occurance. I had near constant bladder spasms. I had several extra month of recovery time. But the one thing I didn’t have to deal with? Dysphoria. I’d rather deal with physical discomfort over dysphoria any day.
Up until my most recent surgery, I had practically no dysphoria. Since my last surgery I’ve been peeing out of where the female urethral opening would be which has caused a tiny amount of dysphoria but it’s not enough to impact my life. And it’s only for 3 months. Besides that, none. Yes I get self conscious about my hips, my height, lack of facial hair, and other somewhat feminine features. But it’s just that. Self consciousness, not dysphoria.
I’m happier than I’ve ever been. No words can describe how good it feels to look down and see what was always supposed to be there. Feeling my dick when something brushes against it. Getting in the shower and my dick not coming off when I take off my clothes. It just feels right.
A similar but slightly different question I get is whether I’d do it all over again. The answer to that one is more complicated. Yes I would definitely still have phalloplasty. I might reconsider certain aspects, though. I would look more into having urethral lengthening in a separate stage. I’d grow some balls (lol) to get over my fear of drs and go as soon as there was a problem. I’d also definitely take off a year from college.
So long story short, was phalloplasty worth it? So worth it that words can’t describe it.
I got an anon a while ago asking to post pics in boxers and sweats. I meant to post this when I first got the ask but the app kept crashing.
1-flopped to the side in tight boxer briefs
2- straight down in tight boxer briefs
3- straight down in looser boxer briefs
4- in loose gym shorts
Couldn’t find any sweats sorry.
This is part 3 in a series of posts summarizing what was said during the Gender Odyssey conference in Seattle from August 14-17, 2014. This is a mix of basic and supplemental knowledge. This is knowledge to expand upon what you already know but may not provide groundwork for fully understanding it otherwise.
Dr. Webb – Scottsdale, Arizona. Co-surgeon of Dr. Meltzer
Dr. Nicole – Burlingame, California. Co-surgeon of Dr. Bowers
Dr. Crane - San Francisco, California (mentioned)
There are 3 main forms of hysterectomy operations available and what you choose will impact the price, risks involved, and recovery time you will experience:
Total Abdominal Hysterectomy (TAH) – An incision is made across the abdominal wall, cutting through skin and connective tissue. Longest healing time, most pain, leaves a 5 inch scar on the abdomen. 6 weeks to return to normal activity levels.
Vaginal Hysterectomy – An incision is made at the top of the vagina. Faster healing time than the TAH, but it’s like operating through a long, narrow tube, so surgeons can’t view your other organs. Less pain than TAH, faster recovery, but you’ll bleed out of that area for a little while. 2 weeks to return to normal activity levels, with restrictions placed on heavy lifting.
Laparoscopic Hysterectomy – Small incisions are made in the abdomen (1/4th of an inch or so) and laparoscopic tools are used. This gives the surgeon a full view of the abdomen. This is usually the cheapest method, is minimally invasive, and has the fastest recovery time. This is the operation I would opt for, personally. 6 days-2 weeks to turn to normal activity levels, with restrictions on heavy lifting.
The prices of these operations vary, but Dr. Nicole listed the prices of her and Dr. Bowers as (and this includes hospital fees):
$13,000 – Laparoscopic with Dr. Nicole
$17,000 – Abdominal or vaginal with Dr. Bowers
Dr. Webb mentioned something that I can’t verify. He talked about how doctors will leave pieces behind sometimes when performing hysterectomies, sometimes even a full ovary, and that when he performs a vaginectomy he always checks to make sure everything has been properly removed. I don’t know whether or not to believe him, but with the way he spoke about it I feel the need to. I’m torn about this.
There is no real medical benefit for having a hysterectomy performed. There have been no proven instances of testosterone therapy in transgender men increasing rates of cancer in our reproductive organs (cervical, ovarian, etc.). In the Hormones 101 workshop it was even discussed that a recent study might suggest that testosterone prevents ovarian cancer, but this was measured in cis women taking small doses. At this time no long term studies have been performed specifically assessing whether or not testosterone increases rates of cancer in our reproductive organs, but anecdotal information from doctors and surgeons with 15+ years of experience treating trans populations suggests that there is no link. I’m inclined to believe this. There are two main reasons a person will opt for a hysterectomy:
1) They have no desire to have these parts inside of them as they were never meant to have them
2) Pain. Dr. Nicole explained that on testosterone the uterus becomes small. As it shrinks down it pulls on the surrounding muscles, specifically the round ligaments, which can cause cramping/contractions which can be very painful. I’ve experienced this myself and it’s fairly common.
Trying to get a hysterectomy done when you are young is quite a pain but it isn’t impossible. This is because it is voluntary sterilization and there is a dark history around the sterilization of populations and a lot of stigma associated with that. Most places want you to be at least 21, but getting them under this age (or underage in general) is not impossible.
- If you have a vaginectomy you absolutely need to have a hysterectomy.
- You can have a vaginectomy done without having any form of bottom surgery.
- You can have urethral lengthening done without needing a vaginectomy. Dr. Crane and Dr. Bowers allow this, but Dr. Meltzer requires one to be performed if UL happens. This is because leaving the vagina increases the complication rates associated with UL.
The urethra runs along the top of the vagina. When performing urethral lengthening the original urethra needs to have an extension placed at the end of it at a 90 degree angle so that it can be rerouted to allow you to pee from the newly positioned opening. This is a lot of work going on in a small area, so if you don’t have a vaginectomy done then they need to both maintain the vagina while supporting this very delicate urethral lengthening process, which is where the complications come in. Mucosa is what supplies blood flow to the urethra and proper blood flow is necessary for healing to occur, so when the blood flow is limited then complications arise and the urethra can fail. If you perform a vaginectomy and sew the walls of the vagina shut, then blood vessels from both sides of the vagina will supply more blood to the urethra and lower the rate of complications. Sewing these walls shut also provides support for the bowels and the bladder so that they stay in place as you age.
Dr. Crane described complication rates associated with UL and a vaginectomy at about 10-20%, whereas without a vaginectomy complication rates increase to at least 25%. These estimates seemed a little conservative based on what I’ve heard, but I’ll leave it at that.
As current medical science stands the answer is: rarely.
If the skenes gland is kept intact then there is a chance that you will be able to ejaculate after bottom surgery. It would be a clear fluid that dribbles out rather than forcefully ejaculating, but that’s about it.
Let’s work through this so that it’s clear why this isn’t possible right now. It’s helpful when you can logically understand it instead of getting a short “yes” or “no” answer. To ejaculate in the way that a cis male does you’d require functioning testicles and you’d require vas defrens. The testicles would produce semen, the stuff you’d be ejaculating during orgasm, and the vas defrens is the passage way for semen to go from the testicles to the urethra. Once the seminal fluid is in the urethra the body also needs a mechanism for the bladder neck to close off, preventing retrograde seminal movement which would allow the semen to go into the bladder. It’s amazing how complicated an orgasm is and how quickly all of this happens. After that contractions of the pelvic floor force the semen out and that’s where the ejaculation occurs. The prostate, bulbourethral gland, and a few others things are all involved in this but I narrowed it down to what would most likely be the bare minimum for ejaculation (I could be wrong).
So with this in mind let’s consider what is and isn’t possible right now in medical science. With phalloplasty we can create an aesthetically pleasing, fully sensate penis of average size that one can use to urinate from and can achieve orgasm with. It can’t get hard on it’s own and it you can’t ejaculate from it, but otherwise you’ve essentially got all of your basis covered. Creating the urethra itself is difficult enough as is and that’s where 95% of complications from phalloplasty happen, so forming vas defrens and connecting this to the urethra at this time isn’t possible. Neither is the mechanism to close off the bladder or the ability to create functioning testicles. That would require an incredible amount of microsurgery. However, that doesn’t mean it won’t ever be possible. Medical science is advancing by lightyears all the time and there is a team who was recently (last year, I believe) given grants necessary to conduct 5 years of research into medical procedures for veterans, including growing penises. At this time we have the technology to grow full urethras, functioning livers, functioning kidneys, etc. - It won’t be long before this is part of our future. If the research by the medical team I listed just a moment ago goes well it could be as little as 5 years.
De Cuypere et al. evaluated sexual and physical health after sex reassignment surgery in 2005, with the mean followup of 6.2 years in female to male transsexuals. They observed improvement of many parameters of sexual life after female to male transition.
- Sexual satisfaction with a partner after surgery was reported by 81.9% of patients, compared to 50% prior to surgery
- Orgasm frequency increased from 45.5% to 77.8%
- Frequent sexual arousal increased from 40% to 60.9%
- Frequent masturbation increased from 20% to 78.3% of participants
- Overall sexual satisfaction was reported in 76.2% of the cases, with 19% of unsatisfied patients
Some of these changes can be contributed to the influence of male hormones on sexual behavior and libido, as reported.
Results from an April 2014 study conducted in Belgrade, Serbia:
- Overall sexual satisfaction is documented in 87.6% of the cases
- Orgasm when masturbating is documented in 70%
- Erection of the neophallus and sexual arousal is documented in 100%
In my ongoing bottom surgery research, I’ve come across some really great Meto results on Dr. Cranes site. I’m really impressed with Patient C’s penis results, especially since it looks uncircumcised (Link to results below). The thing that really stands out for me is where everything is places and how the testicles seem very much like a cis mans would be.
I just wonder how much growth one needs to have to qualify for this procedure.